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  • BCalvert
    Participant
    Post count: 4

    Thank you for taking a look at this Dr. I had a successful 6mm herniation removal with an l4/l5 mirodiscectomy on 2/25/2020. All was good and I was making progress. At that time the MRI showed I also had 2mm bulges at l3/l4 and l5/s1.
    A little over a year later. March or 2021 I started to have flare ups and pain again. First it was right side with pain in buttocks and down leg. Similiar to what I have felt in past. It comes and goes with no rhyme or reason it seams. I also have down left side as well but not consistently. This in in buttocks, but also down front of hip, thigh and to the knee. Also in groin slightly. I was given a second MRI for comparison with and without contrast. As well as xrays and this is what it said below. I am just comletely disheartened as to what to do. I assume I am going to just need to get used to life with pain. I see the Neurosurgeon in a 10 days to discuss the below findings. I have not been able to push myself with home PT and stengthening as I am/was afraid of making it worse. But it might be I got that all wrong. I am a healthy 5’7′ and 160 pound and up until this was very active in gym etc. Is there any hope for me here and what would you recommend as course of action? Epidural Injections?

    I should add my pain levels are 3 on average with occational 5 at its worst right now. On days its a 1 or 2 I feel the weight of the world lifted off me. I have not taken a dose pak yet and have never been on any neurontins. I manage it fairly well with Ibuprofen and Tylenol, ice and rest if needed.

    XRAY: Vertebral body heights are normal. There is intervertebral
    disc space narrowing at L4-5. There is a minimal degree of perceived
    retrolisthesis of L4 on L5 which remains fixed between flexion and
    extension. No other significant spondylolisthesis is seen. Minimal
    degree of anterior osteophyte formation seen at L3-4.

    MRI FINDINGS:
    Subtle dextroscoliosis of the lumbar spine is noted on the coronal
    images. Slight straightening of normal lumbar lordosis is noted
    suggestive of muscle spasm. Slight decreased disc height and hydration
    is noted at the L3-4 and L4-5 levels. There is no focal marrow
    replacement or marrow edema of the lumbar vertebrae. The conus
    medullaris appears within normal limits terminating at the L1 level.
    The presence of 5 lumbar vertebrae is presumed.

    T12-L1: There is no central canal or foraminal stenosis. No
    significant posterior disc protrusion is evident.

    L1-2: There is no central canal or foraminal stenosis. No significant
    posterior disc protrusion is evident.

    L2-3: There is no central canal or foraminal stenosis. No significant
    posterior disc protrusion is evident.

    L3-4: There is a diffuse disc bulge of the annulus fibrosus measuring
    approximately 2 mm AP dimension which encroaches upon the anterior
    surface of the thecal sac. Central annular tear is again noted.
    Together with facet joint degenerate changes, ligamentum flavum
    hypertrophy and posterior epidural lipomatosis a minimal degree of
    central canal stenosis is noted. No significant foraminal stenosis is
    evident. Essentially stable appearance is noted at this level when
    compared to prior study.

    L4-5: Since previous examination there has been right hemilaminotomy
    with discectomy. Previously noted right paracentral disc herniation of
    the protrusion type is no longer evident. There is no central canal
    stenosis. No significant enhancing soft tissue/epidural fibrosis/scar
    is evident. A mild degree of right foraminal stenosis is noted due to
    right posterior lateral bulging and facet joint degenerative changes
    with encroachment upon the exiting right L4 nerve root. Progression in
    this area is noted when compared to prior study. This is best
    visualized on sagittal T2 weighted image 12.

    L5-S1: There is a diffuse disc bulge of the annulus fibrosus measuring
    less than 2 mm in AP dimension which encroaches upon the anterior
    surface of the thecal sac. No significant foraminal stenosis is
    evident. Minimal facet joint degenerate changes are evident. There is
    essentially stable appearance at this level when compared to prior
    study.

    CONCLUSION:

    1. Slight straightening of normal lumbar lordosis is noted consistent
    with muscle spasm. Subtle dextroscoliosis of the lumbar spine is
    noted.

    2. There is essentially stable appearance of intervertebral disc
    pathology at the L3-4 and L5-S1 levels as detailed above.

    3. Since previous examination postsurgical changes are noted at the
    L4-5 level as detailed above. No recurrent central disc protrusion is
    evident. Right foraminal stenosis is noted at this level as detailed
    above which appears to represent progression since previous
    examination.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    Your MRI notes; L3-4: “Together with facet joint degenerate changes, ligamentum flavum hypertrophy and posterior epidural lipomatosis a minimal degree of central canal stenosis is noted. No significant foraminal stenosis is evident”.
    L4-5: ‘A mild degree of right foraminal stenosis is noted due to right posterior lateral bulging and facet joint degenerative changes with encroachment upon the exiting right L4 nerve root”.
    L5-S1:”No significant foraminal stenosis is evident”

    Your symptoms on the left sound more like an L3 or L4 nerve root (This in in buttocks, but also down front of hip), as pain in the thigh and to the knee.irritation would be generated by the L3-4 or L4-5 level, either from foraminal or lateral recess compression. See https:
    //neckandback.com/conditions/foraminal-collapse-lumbar-spine/ and
    https://neckandback.com/conditions/lateral-recess-stenosis/

    One of the key questions is whether the symptoms are aggravated by standing and relieved by sitting or lying down.

    If so, you then can consider a selective nerve root block and a pain diary to see if this root is causing the symptoms. See:
    https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/
    https://neckandback.com/treatments/diagnostic-vs-therapeutic-injections/ and
    https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections/

    Dr. Corenman

    BCalvert
    Participant
    Post count: 4

    Wow. Thank you for the quick reply. I have been trying to narrow down what makes it feel better. Specifically the left side when active pain. Thinking back and thru yesterday and today, I would say laying down releives the left side pain. Sitting does somewhat but not as much as lying down. I have several things going on there so maybe they overlap?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    If your pain in your leg develops from activity (standing or being upright), then the noted hyperlinks I gave you would fit with those symptoms.

    Dr. Corenman

    BCalvert
    Participant
    Post count: 4

    Thank you

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